DEAR DR. ROACH: I am a paraplegic due to a spinal cord injury back in 1979. I battle one UTI after another, and I am becoming immune to most antibiotics. Why the constant infections? My urologist just ordered a CT scan but seems uninterested in me as a patient. I am sick of being sick. I straight catheterize four times a day usually. It's getting very hard for them to match the antibiotic to the culture. At times the infections are so bad I get "foggy headed." These times I am in misery. The last time I went to the ER hoping it wasn't sepsis. They gave me antibiotics. I can't keep running to the ER. My copays are too much. Maybe I need a doctor who specializes in working with people who have a spinal cord injury. — Anon.
ANSWER: Regular drainage of the bladder with a "straight catheter" is the most effective way to reduce the risk of urine infections in a person with a spinal cord injury, but it is not perfect. People may still get bacteria in the bladder. Although it may be worthwhile to review your catheterization technique with an expert, it's possible to get infections even with perfect technique.
You haven't become immune to antibiotics, but the frequent use of powerful antibiotics will make you colonized with resistant bacteria, so that if you do get an infection, it's likely to be with a difficult-to-treat organism.
The CT scan is a good idea to see whether there is an anatomic reason for recurrent (or persistent) infections. I am disappointed to hear your urologist does not seem to be doing his or her best for you.
Recurrent infections are dangerous. Becoming foggy headed is a sign of serious systemic infection, and sepsis (a dysfunctional body response to infection) is life-threatening. Some people take antibiotics to prevent infection. Often, these are rotated to reduce resistance.
An urologist experienced in spinal cord injury, perhaps in consultation with an infectious disease doctor, would be ideal.
DEAR DR. ROACH: You recently wrote that you had seen doctors and nurses with "DNR" tattooed on their chests. Were they still on the job, or retired and not in good health? — P.
ANSWER: The two health care professionals I recall with these tattoos were young and healthy. Both of them watched many people undergo long, painful, expensive hospital courses that ended in a death without dignity. It was in response to these bad outcomes that they made a request against attempts at cardiopulmonary resuscitation.
As I said, I disagree with the tattoo. It is not considered a legal document, and it is worthwhile to make a legally binding document. I recommend www.agingwithdignity.org and www.caringinfo.org as good places to start. There are many others, including attorneys who specialize in end-of-life issues.
There are many cases in which an attempt at resuscitation is appropriate! A person who has a heart attack can be revived with CPR and have an excellent quality of life for years thereafter. DNR orders are most appropriate for people with chronic medical illnesses, and most legal documents specify whether the order is applicable only in the event of an illness judged likely to be terminal. It's important to have a living will and a health care proxy identified long before there is a crisis. It is critical for a person to discuss their wishes with their proxy.